The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended Adult
Immunization Schedule to ensure that the schedule reflects current recommendations for the use of licensed vaccines. In June 2005,
ACIP approved the Adult Immunization Schedule for October
2005--September 2006. This schedule has also been approved by
the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

Changes in the Schedule for October 2005--September 2006

The 2005--2006 schedule differs from the previous
schedule as follows:

Vaccines listed on the age-based schedule (Figure 1) are displayed so that vaccines recommended for routine use can
be differentiated from those recommended for adults with certain risk indicators (similar to the
childhood immunization schedule). This is illustrated both by the color scheme and by the broken line.

The yellow bars ("For all persons in this group") and the green bars ("For persons lacking documentation of
vaccination or evidence of disease") from the previous schedule have been merged into one yellow bar, which now reads, "For
all persons in this category who meet the age requirements and who lack evidence of
immunity (e.g., lack documentation of vaccination or have no evidence of prior infection)."

The purple bar has been changed from "For persons at risk (e.g., with medical/exposure indications)"
to "Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or
other indications)." The purple bar was added to the 50--64
years and >65 years age-group columns for
measles, mumps, rubella (MMR) vaccine.

The column, "Diabetes, heart disease, chronic pulmonary disease, or chronic liver disease including chronic
alcoholism" has been transposed with the column,
"Congenital immunodeficiency, leukemia, lymphoma, generalized
malignancy, therapy with alkylating agents, antimetabolites, cerebrospinal fluid leaks, radiation, or large amounts of corticosteroids"
on the medical/other indications schedule (Figure 2) so that contraindications for MMR and varicella vaccines are now
side-by-side.

The row for varicella vaccine has been moved up on both figures (i.e., to immediately after MMR vaccine) because the vaccine
is now universally recommended for certain age groups.

Meningococcal vaccine has been added to the medical/other indications schedule (Figure 2). The footnote has
been revised to incorporate the recently published ACIP recommendations for this vaccine
(1).

The tetanus and diphtheria footnote (#1) has been reworded.

The varicella footnote (#3) has been reworded in accordance with ACIP recommendations adopted in June 2005.

The influenza footnote (#4) has been revised to add the newest high-risk condition: neuromuscular conditions
that compromise respiratory function (2).

Approved by the Advisory Committee on Immunization Practices, the American College
of Obstetricians and Gynecologists, and the American Academy of Family Physicians

1. Tetanus and diphtheria (Td) vaccination. Adults with uncertain histories of a complete primary vaccination series with diphtheria and tetanus
toxoid--containing vaccines should receive a primary series using combined Td toxoid. A primary series for adults is
3 doses; administer the first 2 doses at least 4 weeks apart and the third dose 6--12 months after the second. Administer 1 dose if the person received the primary series and if the
last vaccination was received >10 years previously. Consult the ACIP statement for recommendations for administering Td as prophylaxis in
wound management (http://www.cdc.gov/mmwr/preview/mmwrhtml/00041645.htm). The American College of Physicians Task Force on Adult
Immunization supports a second option for Td use in adults: a single Td booster at age 50 years for persons who have completed the full pediatric series, including
the teenage/young adult booster. A newly licensed tetanus-diphtheria-acellular--pertussis vaccine is available for adults. ACIP recommendations for its
use will be published.

2. Measles, mumps, rubella (MMR) vaccination.
Measles component: adults born before 1957 can be considered immune to
measles. Adults born during or after 1957 should receive
>1 doseof MMR unless they have a medical contraindication, documentation of
>1 dose, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity. A second dose of MMR
is recommended for adults who 1) were recently exposed to measles or in an outbreak setting; 2) were previously vaccinated with
killed measles vaccine; 3) were vaccinated with an unknown type of measles vaccine during 1963--1967; 4) are students in
postsecondary educational institutions; 5) work in a health-care facility; or 6) plan to travel internationally. Withhold MMR or other
measles-containing vaccines from HIV-infected persons with severe immunosuppression.
Mumps component:1 dose of MMR vaccine should be
adequate for protection for those born during or after 1957 who lack a history of mumps based on health-care provider diagnosis or who
lack laboratory evidence of immunity. Rubella
component:administer 1 dose of MMR vaccine to women whose rubella vaccination history
is unreliable or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, routinely
determine rubella immunity and counsel women regarding congenital rubella syndrome. Do not vaccinate women who are pregnant or who
might become pregnant within 4 weeks of receiving vaccine. Women who do not have evidence of immunity should receive MMR
vaccine upon completion or termination of pregnancy and before discharge from the health-care facility.

3. Varicella vaccination. Varicella vaccination is recommended for all adults without evidence of immunity to varicella.
Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (health-care workers
and family contacts of immunocompromised persons) or 2) are at high risk for exposure or transmission (e.g., teachers of young
children; child care employees; residents and staff members of institutional settings, including correctional institutions; college students;
military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and
international travelers). Evidence of immunity to varicella in adults includes any of the following: 1) documented age-appropriate varicella
vaccination (i.e., receipt of 1 dose before age 13 years or receipt of 2 doses [administered at least 4 weeks apart] after age 13 years); 2)
U.S.-born before 1966 or history of varicella disease before 1966 for non-U.S.--born persons; 3) history of varicella based on health-care
provider diagnosis or parental or self-report of typical varicella disease for persons born during 1966--1997 (for a patient reporting a history of
an atypical, mild case, health-care providers should seek either an epidemiologic link with a typical varicella case or evidence of
laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on health-care provider diagnosis; or
5) laboratory evidence of immunity. Do not vaccinate women who are pregnant or who might become pregnant within 4 weeks of
receiving the vaccine. Assess pregnant women for evidence of varicella immunity. Women who do not have evidence of immunity should
receive dose 1 of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. Dose
2 should be administered 4--8 weeks after dose 1.

4. Influenza vaccination.Medical
indications:chronic disorders of the cardiovascular or pulmonary systems, including asthma;
chronic metabolic diseases, including diabetes mellitus, renal dysfunction, hemoglobinopathies, or immunosuppression
(including immunosuppression caused by medications or HIV); any condition (e.g., cognitive dysfunction, spinal cord injury, seizure disorder,
or other neuromuscular disorder) that compromises respiratory function or the handling of respiratory secretions or that can increase
the risk for aspiration; and pregnancy during the influenza season. No data exist on the risk for severe or complicated influenza
disease among persons with asplenia; however, influenza is a risk factor for secondary bacterial infections that can cause severe
disease among persons with asplenia. Occupational
indications:health-care workers and employees of long-term--care and assisted
living facilities. Other indications: residents of nursing homes and other long-term--care and assisted living facilities; persons likely to
transmit influenza to persons at high risk (i.e., in-home household contacts and caregivers of children aged 0--23 months, or persons of all
ages with high-risk conditions), and anyone who wishes to be vaccinated. For healthy, nonpregnant persons aged 5--49 years without
high-risk conditions who are not contacts of severely immunocompromised persons in special care units, intranasally
administered influenza vaccine
(FluMist®) may be administered in lieu of inactivated vaccine.

6. Revaccination with pneumococcal polysaccharide
vaccine. One-time revaccination after 5 years for persons with chronic
renal failure or nephritic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); immunosuppressive
conditions (e.g., congenital immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma, Hodgkin disease, generalized malignancy,
or organ or bone marrow transplantation); or chemotherapy with alkylating agents, antimetabolites, or long-term systemic
corticosteroids. For persons aged >65 years, one-time revaccination if they were vaccinated
>5 years previously and were aged <65 years at the time
of primary vaccination.

7. Hepatitis A vaccination.Medical
indications:persons with clotting-factor disorders or chronic liver disease.
Behavioral indications:men who have sex with men or users of illegal drugs.
Occupational indications: Persons working with hepatitis A virus
(HAV)--infected primates or with HAV in a research laboratory setting.
Other indications: persons traveling to or working in countries that have high
or intermediate endemicity of hepatitis A (for list of countries, see
http://www.cdc.gov/travel/diseases.htm#hepa) as well as any
person wishing to obtain immunity. Current vaccines should be administered in a 2-dose series at either 0 and 6--12 months, or 0 and
6--18 months. If the combined hepatitis A and hepatitis B vaccine is used, administer
3 doses at 0, 1, and 6 months.

8. Hepatitis B vaccination.Medical
indications:hemodialysis patients (use special formulation [40
µg/mL] or two 20-µg/mL doses)
or patients who receive clotting-factor concentrates.
Occupational indications: health-care workers and public-safety workers who
have exposure to blood in the workplace and persons in training in schools of medicine, dentistry, nursing, laboratory technology, and
other allied health professions. Behavioral
indications: injection-drug users; persons with more than one sex partner during the previous
6 months; persons with a recently acquired sexually transmitted disease (STD); and men who have sex with men.
Other indications: household contacts and sex partners of persons with chronic hepatitis B virus (HBV) infection; clients and staff members of
institutions for developmentally disabled persons; all clients of STD clinics; inmates of correctional facilities; and international travelers who will be
in countries with high or intermediate prevalence of chronic HBV infection for more than 6 months (for list of countries, see
http://www.cdc.gov/travel/diseases.htm#hepa).

9. Meningococcal vaccination.Medical
indications: adults with anatomic or functional asplenia or terminal complement
component deficiencies. Other
indications:first-year college students living in dormitories; microbiologists who are routinely exposed to isolates
of Neisseria meningitidis; military recruits; and persons who travel to or reside in countries in which meningococcal disease
is hyperendemic or epidemic (e.g., the "meningitis belt" of sub-Saharan Africa during the dry season [December--June]), particularly
if contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to
Mecca during the annual Hajj. Meningococcal conjugate vaccine is preferred for adults meeting any of the above indications who are aged
<55 years, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Revaccination after 5 years might
be indicated for adults previously vaccinated with MPSV4 who remain at high risk for infection (e.g., persons residing in areas in
which disease is epidemic).

10. Selected conditions for which Haemophilus influenzae
type b (Hib) vaccine may be used. Hib conjugate vaccines are
licensed for children aged 6--71 months. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine
for older children and adults with the chronic conditions associated with an increased risk for Hib disease. However, studies suggest
good immunogenicity in patients who have sickle cell disease, leukemia, or HIV infection or who have had splenectomies;
administering vaccine to these patients is not contraindicated.

The Recommended Adult Immunization Schedule has been approved by the Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists,
and the American Academy of Family Physicians. The standard
MMWR footnote format has been modified for publication of this schedule.

This schedule indicates the recommended age groups and medical indications for routine administration of
currently licensed vaccines for persons aged
>19 years. Licensed combination vaccines may be used whenever any components of
the combination are indicated and when the vaccine's other components are not contraindicated. For detailed
recommendations, consult the manufacturers' package inserts and the complete statements from ACIP
(http://www.cdc.gov/nip/publications/acip-list.htm).

Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System
(VAERS). Reporting forms and instructions on filing a VAERS report are available by telephone, 800-822-7967, or from the
VAERS website at http://www.vaers.hhs.gov.

Information on how to file a Vaccine Injury Compensation Program claim is available at
http://www.hrsa.gov/osp/vicp or
by telephone, 800-338-2382. To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison
Place, N.W., Washington, DC 20005, telephone 202-357-6400.

Additional information about the vaccines listed above and contraindications for vaccination is also available at
http://www.cdc.gov/nip or from the CDC-INFO Contact Center at 800-CDC-INFO (232-4636) in English and Spanish, 24
hours a day, 7 days a week.

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Health and Human Services.References to non-CDC sites on the Internet are
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endorsement of these organizations or their programs by CDC or the U.S.
Department of Health and Human Services. CDC is not responsible for the content
of pages found at these sites. URL addresses listed in MMWR were current as of
the date of publication.

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